Endoscopic preaponeurotic mesh placement in cases of divarication of recti associated or not with midline hernia

Abstract

Background Divarication of rectus abdominis muscle is common especially after childbirth. Usually it is asymptomatic but may be associated with backache. Its problem is mainly esthetic and managed by plastic surgeons. General surgeons are called for management of divarication if associated with hernia defects. Till now, there is no unique procedure for the optimal management of divarication of recti associated with midline hernia defects. Open surgical repair, subcutaneous endoscopic repair, and transabdominal laparoscopic repair all with or without mesh fixation could be an accepted solution. Aim of the study The aim of this study is to evaluate the subcutaneous endoscopic plication of the divarication of rectus abdominis muscle, repair of the hernia defect if present, and placement of preaponeurotic nonabsorbable mesh. Patients and methods The study is a prospective clinical trial carried out in Zagazig university hospitals in the period between March 2018 and October 2018, where endoscopic placement of nonabsorbable prolene mesh on the anterior rectus sheath after plication and repair of the defect in cases of divarication of rectus abdominis muscles associated or not with midline hernia was done. Results A total of 19 patients underwent endoscopic plication of rectus abdominis muscle; 12 of them had midline hernia, in whom repair of the defect was done, and the nonabsorbable mesh was placed over the anterior rectus sheath, with good outcome comparable to most studies on that topic, apart from seroma, which occurred in five cases, and prolonged operative time. Conclusion Preaponeurotic endoscopic technique for plication of divarication of rectus abdominis muscle and onlay mesh placement is better than open surgical management. It is a safe, reproducible, and effective alternative for patients with ventral hernias associated with divarication of rectus abdominis muscle.